Breakdowns in communication of radiological findings: an ethical and medico-legal conundrum.
Breakdowns in communication of radiological findings: an ethical and medico-legal conundrum.
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放射学发现的交流中的崩溃：道德和医疗法律的难题。
DOI：
10.1515/dx-2014-0034
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发表时间：
2014-12
期刊：
影响因子：
--
通讯作者：
Singh H
中科院分区：
文献类型：
--
作者：
Berlin L;Murphy DR;Singh H
近年来，诊断测试中的沟通问题在数量和重要性上都有所增加。沟通失败的医疗和法律的影响是巨大的。在过去的几十年里，法院已经扩大和加强了放射科医生的义务，即在某些情况下及时向转诊医生甚至病人本人传达放射异常。传达这些调查结果的必要性超出了严格的法律的要求：还有一种道德上的必要性。美国医学会的《医学伦理准则》指出，“道德价值观和法律的原则通常密切相关，但道德义务通常超过法律的义务。”因此，从法律的角度来看，放射科医生必须及时向转诊医生或患者本人传达重要的意外发现。从道德的角度来看，放射科医生应该想要实现这样的沟通。实践标准，道德价值观和职业医学会的道德声明要求向受其影响的患者充分披露医疗错误。对放射科医生和非放射科医生的调查显示，只有少数人会向患者透露错误的所有方面。为了鼓励医生向患者披露错误，并在医疗事故诉讼发生时以某种方式帮助保护他们，超过35个州通过了法律，不允许医生在法庭上承认错误和道歉。这种披露是否会增加或减少医疗事故诉讼的可能性尚不清楚，但伦理和道德考虑要求医生披露错误并道歉。
Communication problems in diagnostic testing have increased in both number and importance in recent years. The medical and legal impact of failure of communication is dramatic. Over the past decades, the courts have expanded and strengthened the duty imposed on radiologists to timely communicate radiologic abnormalities to referring physicians and perhaps the patients themselves in certain situations. The need to communicate these findings goes beyond strict legal requirements: there is a moral imperative as well. The Code of Medical Ethics of the American Medical Association points out that “Ethical values and legal principles are usually closely related, but ethical obligations typically exceed legal duties.” Thus, from the perspective of the law, radiologists are required to communicate important unexpected findings to referring physicians in a timely fashion, or alternatively to the patients themselves. From a moral perspective, radiologists should want to effect such communications. Practice standards, moral values, and ethical statements from professional medical societies call for full disclosure of medical errors to patients affected by them. Surveys of radiologists and non-radiologic physicians reveal that only few would divulge all aspects of the error to the patient. In order to encourage physicians to disclose errors to patients and assist in protecting them in some manner if malpractice litigation follows, more than 35 states have passed laws that do not allow a physician’s admission of an error and apologetic statements to be revealed in the courtroom. Whether such disclosure increases or decreases the likelihood of a medical malpractice lawsuit is unclear, but ethical and moral considerations enjoin physicians to disclose errors and offer apologies.